Concordance and discrepancy in sexual identity, attraction, and behavior among adolescents

Nonheterosexual youth are at greater risk for mental and physical health problems than heterosexual youth. Definitions of nonheterosexual youth, however, are not consistent between studies, variably including sexual identity, attraction, and/or behavior. This study's objective was to describe the concordance and discrepancy between sexual identification, attraction, and behavior in adolescents.

A total of 1,951 students aged 14 and older from 14 high schools in Montreal, Quebec, were surveyed anonymously using the Quebec Youth Risk Behaviour Survey. The survey included three items assessing sexual orientation (sexual identity, sexual attraction, sexual behavior).

Twelve percent of adolescents (n=237) endorsed at least one measure of nonexclusive heterosexuality. A total of 3.4% reported gay/lesbian or bisexual (GLB) identity (another 3.4% were unsure), 9.0% reported same-gender attraction, and 4.0% same-gender behavior. There was no consistent pattern of overlap between the three measures, and no single dimension effectively captured this population. The question about attraction identified 71%; identity identified 52%; and behavior only 31%. In raw numbers, more heterosexually identified students reported same-gender attraction (n=95) or same-gender behavior (n=33) than GLB-identified students (n=44 and 29, respectively).

"Nonheterosexual" youth are a heterogeneous group that cannot be identified accurately using a single question. In both research and clinical settings, the best way to assess sexual orientation, consistent with American Academy of Pediatrics, is to ask multiple questions that address the dimensions of identity, attraction, and behavior. All youth who endorse any combination of nonexclusively heterosexual identity, behavior, or attraction are potentially at risk for the ill effects of direct and indirect discrimination.